Relevance. The COVID-19 pandemic has once again shown how important it is to follow the principles of evidence-based medicine in etiopathogenetic therapy. Treatment of COVID-19 and its complications, carried out on the basis of individual publications, in fact, having the status of a series of clinical cases, as a rule, did not bring the desired result. Objective: to study the safety of transfusion of single-group hyperimmune plasma of convalescents containing a high titer of antibodies to the RBD domain of the S-protein SARS-CoV-2 in patients with moderate and severe forms of COVID-19 in the framework of a prospective comparative clinical study. Results. It was found that after plasma transfusion of convalescents to patients in a severe and extremely severe condition on the day of the start of mechanical ventilation or being on mechanical ventilation, the 30-day mortality rate was 60%, which did not differ from the lethality of the control group, which included 70 completed cases in which mechanical ventilation was performed. (57.9%). On the contrary, the mortality rate in moderate and severe patients who received plasma while on spontaneous breathing was significantly lower than the average hospital mortality in our hospital (4.3% and 6.73%, respectively), and also significantly lower than the mortality in the control group receiving non-immune plasma (10.0%). When transfusing anticoid plasma, the most frequently observed adverse events were allergic reactions in the form of urticaria and a febrile non-hemolytic reaction. A serious adverse event in the form of non-cardiogenic pulmonary edema has been reported once. Conclusions. 1. Convalescent plasma prescribed to patients with severe COVID-19 who are on mechanical ventilation does not affect the outcome of the disease. 2. Convalescent plasma prescribed to patients with moderate and severe COVID-19 who are on spontaneous respiration significantly reduces hospital mortality in these patients. 3. Transfusion of convalescent plasma can cause serious adverse events, therefore, when prescribing plasma therapy, it is necessary to weigh the risk of mortality from disease progression and the potential risks from plasma transfusion in each case.

This study presents joint work experience of the structural divisions of the Federal Siberian Scientific and Clinical Center (FSSCC) as a unified outpatient computed tomography diagnostics center (OCTDC) created to carry out comprehensive medical examination of the population under FSSCC during coronavirus-disease 2019 outbreak as well as patients of medical organizations of the Krasnoyarsk urban area. A patient routing scheme was designed and implemented in OCTDC, and its further interaction with territorial polyclinics and hospitals redesigned into temporary infectious disease hospitals was presented. When planning the work of OCTDC, special emphasis is placed on anti-epidemic measures as well as elements of cost-effectiveness in an outpatient setting. FSSCC was opened for the first time in Krasnoyarsk and became the basis for replicating such computed tomography centers in other medical institutions of the region.

Medical services implementation schemes, based on the optimization of the flow of patient created values, are proposed. Changes appearing in certain performance indicators of the medical organization during the process of new management model introduction are analyzed. Aim. Creation of a management model for a state medical organization in the basis of which are the modern methods based on a process-oriented approach to the separation of management functions. Relevance. The work of healthcare organizations in a highly competitive environment requires more flexibility and mobility, thus the primary task is to create new management models of the organization, taking into account industry characteristics and consumer needs. Materials and Methods. The work uses the published results of the analysis of structural changes in organizational activity by other authors. The study was carried out on the basis of internal documents of the FSFI FSRCC FMBA of Russia on the creation of a new management structure focused on the development of an organization in the conditions of the market of medical services. Analytical and descriptive methods and sociological survey were used. Results and Discussion. Changes in the indicators for service provision for compulsory medical insurance and the volume of medical care provided as a result of the reforms carried out by the management of the healthcare organization of the FSRCC for four years have been analyzed. There was an increase in the number of patients seeking medical services at the FSRCC, who want to receive information/assistance quickly, in accordance with the adopted concept of a client-oriented marketing strategy, which required the development of “short” routes for patients, especially in conditions of increased service. By the joint efforts of marketers and specialist doctors, using design technologies, self-supporting Centres are being formed, which are virtual subdivisions that bring together highly qualified doctors to address the specific needs of patients. The “short” path scheme is based on the adoption of the definition of “medical service” as a unit of measurement of the complexity of the process of “medical care” provision. Conclusions. An increase in the number of visits at the outpatient-polyclinic stage of medical care provision (diagnostics, consultations) over five years doubles the achievement of the goals set for the medical organization, considered as an economic entity of a market economy.

This article presents the experience of implementing psychological support measures for healthcare workers of infectious hospitals for patients with COVID-19 during a pandemic. The results of an empirical study of the prevalence, severity and specificity of the development of anxiety and depressive symptoms in healthcare workers of residents of a megalopolis (Krasnoyarsk), a closed territorial district (Zelenogorsk) and seconded to the North Yenisei district of the Krasnoyarsk Territory depending on social status and professional factors of burnout are presented. The stages of the implementation of measures of psychological support for the activities of healthcare workers are described. A comparative analysis of the involvement of employees of various infectious hospitals was carried out. Material and methods. The total sample of the study included 126 subjects (21 men and 105 women) engaged in the provision of medical care in three infectious diseases hospitals for patients with COVID-l9 in the Krasnoyarsk region. To achieve the goals and objectives of the study, the following methods were used: psychodiagnostic testing with the BDI scale, STAI test and MBI questionnaire, and statistical data processing (Spearman rank correlation coefficient, Mann-Whitney-Wilcoxon U-test). We invited 284 medical workers to participate in psychological support activities. Results and conclusions. The prevalence of subdepression among medical personnel varies from 5.5 to 30.9%, depending on the location of the infectious diseases hospital for patients with COVID-19. Severe depressive symptoms were detected in 4.46% of the total number of subjects. A low level of situational anxiety was detected in less than 30%. It has been confirmed that employees of a younger age and with less experience are more susceptible to the development of depersonalization and cognitive-affective symptoms of depression. And employees who do not have children show higher indicators of situational and personal anxiety. Moreover, despite the prevalence of alarming and depressive symptoms, there is a low involvement and unwillingness of healthcare workers to participate in psychological support activities.

Introduction. The experience of organization of medical activity in the medical institutions subordinate to the FMBA of Russia in the Siberian Federal District during the I-III epidemic waves of COVID-19, the procedure for making and implementing organization and managerial decisions on building the health care system; the analysis of the experience gained in the formation and operation of consolidated mobile emergency response teams was made.Materials and methods. The study was performed on the basis of the statistical data, regulations on the organization of medical care for patients diagnosed with COVID-19, including medical care provision in the extreme conditions.Results and Discussion. The rational distribution of infectious diseases hospitals, human resources and equipment made it possible to create bed capacity reserve, as a result of which, even during the peak episodes of the pandemic process, the average occupancy of beds in the serviced area was no more than 92-93% and there was always the possibility to receive new patients in hospitals; the capacity of the laboratory was gradually increased 25 times: from 200 tests per day in the pre-pandemic period to 5,000 tests per day. Thanks to the introduction of the new management solutions, digitalization of medical processes has been ensured: accounting of results in the medical information system, transmission of results directly to medical institutions within 12-14 hours, which is 4 times faster than the standard time. The legal regulations of interaction with the rescue centres of the Ministry of Emergency Situations of Russia, the Ministry of Defense and other power structures, the improvement of the material and technical equipment of basic mobile hospitals and emergency medical teams were proposed for discussion.Conclusion. A scheme has been worked out for the involvement of the MOF of the Federal Medical and Biological Agency of Russia in the timely organizational measures for mobilization of forces and means in order to ensure the re-profiling of medical activities to work on providing medical care in the COVID-19 pandemic conditions.